AccountId: 011433970860
ContactId: a2abd121-8070-4a04-ae46-4ec9d2248350
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 266239 ms
Total Talk Time (AGENT): 104314 ms
Total Talk Time (CUSTOMER): 113367 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/30/a2abd121-8070-4a04-ae46-4ec9d2248350_20250130T16:59_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi.
[CUSTOMER][NEUTRAL] Good afternoon. Um, I'm not sure if I heard you. Yeah, I'm not sure if I heard your name correctly. I, I guess it's Ay. Yeah, my name is [PII] and last name initial [PII] calling on behalf of Jefferson Health Medical Group, and I'm working on a patient's account. Um, this is about a claim that I just wanted to know the status. Can you help me please?
[AGENT][NEUTRAL] Hello.
[AGENT][NEUTRAL] I'm sure, [PII], I can assist you with claim status. Um, first, I'll need a good callback number in case we're disconnected.
[CUSTOMER][NEUTRAL] Absolutely, yes. Also just a heads up this call is being recorded for quality assurance and training purposes on my end. My best call back number, no extensions [PII].
[AGENT][NEUTRAL] Thank you. Now, I need the policy number, please.
[CUSTOMER][NEUTRAL] Policy number would be
[CUSTOMER][NEUTRAL] 02369768 M as in Mary, L as in Lima, number 8.
[AGENT][NEUTRAL] Thank you. Now, please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] Patient name, Ms. [PII]. Date of birth [PII].
[AGENT][NEUTRAL] OK. Just let me advise you that verification of coverage does not guarantee payment of claims. And um I'm sorry, do you need claim status or to verify benefits?
[CUSTOMER][NEUTRAL] Um, just the claim status, please, thank you.
[AGENT][NEUTRAL] OK. Mhm. What's the date of service and bill charges on the claim?
[CUSTOMER][NEUTRAL] It would, it would be [PII] of service [PII] of last year, [PII]. Bill charges $315 even $315 even.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] OK, thanks for your patience, [PII]. Um, I'm showing that we received that claim on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim processed on [PII].
[CUSTOMER][NEUTRAL] Alright.
[AGENT][NEUTRAL] The claim number is 353-7789 and I'm showing that this claim is denying because office visits are not covered under the policy and then for.
[AGENT][NEUTRAL] Let's see. The line um 9946 for $30. I'm showing that that denied because according to the primary carrier's ELB, the primary insurance covered that charge in full.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I understand, thank you. I, um, I just wanted to know if you process the claim as primary or secondary?
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] It's secondary.
[CUSTOMER][NEUTRAL] A secondary, thank you. Um, last question.
[CUSTOMER][NEUTRAL] Will you be able to, are you gonna be able to send us a copy of the OB maybe by a mail or via fax? Is it possible in your end?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes, I can fax it to you. What's your fax number?
[CUSTOMER][NEUTRAL] Uh yeah, of course, our office fax number I can give you this one to you um [PII].
[AGENT][NEUTRAL] OK, so the fax number is [PII]. I'm sorry. Could I get it again, please?
[CUSTOMER][NEUTRAL] Of course, [PII].
[AGENT][NEUTRAL] OK, so that's attention [PII] [PII].
[CUSTOMER][POSITIVE] Exactly.
[CUSTOMER][POSITIVE] Exactly, yes, I know it's gonna be for me because of the patient's name, yeah, thank you.
[AGENT][POSITIVE] OK. I, I'll send that to you. You should receive it in about 10 minutes. Is there anything else that I can assist you with?
[CUSTOMER][NEUTRAL] Thank you, that's all I need. um, I, I, can you spell out your first name for me just for documentation purposes.
[AGENT][NEUTRAL] Sure. It's um [PII] spelled [PII] [PII] and my name and today's date will be your reference number.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][POSITIVE] Alright, thank you so much, Ms. Ay. Alright, and I think that's gonna be it. I appreciate your help and have a great day. OK, bye for now.
[AGENT][NEUTRAL] Bye. Thank you for calling APL.
[CUSTOMER][NEUTRAL] Bye bye.